This is one happy kid. She’s eating more and more at mealtime ever since the speech therapist gave us some great tips such as:

• Sit with her for 45 minutes to an hour for EACH meal.
• Don’t be control freaks – let her hold the spoon, make a mess, and drink her formula when she wants.
• Make it fun. Let her play with toys, give her lots of choices – different textures, colors and temperatures.

I try to stay relaxed and not rush Emily while she eats. I sit and talk with her and sometimes I read a book. I feed her cheerios (her favorite!) in between bites of baby food and I always have both juice and milk nearby so she gets practice with the cup, but can have her milk if she wants. Lots of times she’ll drink some formula and then start eating solids again. I also give her toys whenever I get up and leave the table to keep her occupied and I always end with a Gerber teething cookie (another favorite). The side effect of all this table time is lots of Emily time. Ana likes to sit at her table and draw while Emily eats and it’s just a very laid back, content time for all of us.

Well, Emily is more than 5 weeks post-op and even though we’ve been trying to get her back on her bottle for two weeks, she still won’t take it and prefers to drink from the Soft Sipps. This is frustrating because the Soft Sipps don’t hold as much formula (only 3.5 ounces) and don’t seem to be made for long-term use. They fall apart after a while and these are not easy bottles to replace!

So this presents a dilemma. Should we force the issue of her bott – simply refuse to give her the Soft Sipps and force feed her until she learns how to eat with her bottle without the NAM? I asked Shelley, the Feeding specialist at NYU and she thought we’d probably have to do that. Apparently it is very rare that a baby won’t take the bottle after surgery. Now, we could force Emily, but she’s not going to get her bottle after her Palate surgery in April so we’d be going through the exact same thing all over again! Jim and I don’t want to put Emily through that torture, so we’ve decided to transition her directly to a cup. It has to be a cup without a spout and apparently Gerber makes one like this so I plan to buy one soon, but in the meantime I rigged something up from one of Ana’s cups and it seems to be working – it is a cup with a lid and a hole for a straw. I put water in it so far and the cup has a raised rim which Emily seems to like. I have to tip the cup a lot and let a little water dribble into her mouth and she actually drinks it (the Soft Sipp is good for training her how to drink from a cup. So far I’ve only introduced the cup at meal times to help clean out her palate while she’s eating. She often eats a few more spoonfuls after she has some water.

It will be a while before Emily can hold her own cup, but if we can switch her to a cup and get rid of the Soft Sipp, life will be much easier. You can put much more fluid in a cup and of course buy them locally.

Our biggest concern with the bottle is that Emily won’t be practicing her sucking, but she seems to love her pacifier so we give that to her all the time. She’s starting to hold the pacifier on her own and that’s a great step to helping her get to sleep too.

Okay, so now that surgery is over we have other things to deal with that I didn’t even consider a few months ago when the NAM was my whole world. One of them is the sleep issues we’re having with Emily, which I mentioned in previous posts. She’s not comfortable falling to sleep on her own and she needs us to rock her a lot. I attribute this to the fact that she was moved from her car seat to her crib and back to her car seat after surgery. We also took away comfort items like her bottle, pacifier (and the NAM!) after surgery. Once the three week recovery was over and we were able to take the arm restraints off, we put her back in her crib and she really started having trouble (she also got sick at this time). She was waking up frequently after we put her down for the night, so we tried a few things and her sleeping is starting to get better. First we have her on a schedule now – two naps a day – morning and afternoon. We also put her down for the night at 7 pm (just started that a couple of days ago) instead of 8:30 which I think was too late. We have the humidifier in her room on low all the time, and I made her crib into a very comfy place with things on the sides, a warm fleece blanket and cotton sheets. So she woke up twice last night between 8 pm and 11 pm, but then slept through until about 7 am this morning – not bad!

Emily loves to sit and play, but she’s resistent to rolling around on the ground on her back or belly. We did not give her much belly time as a small infant due to the NAM and then surgery.

The other issue we’re having is her transition to solid foods. This may be something contributing to her sleep problems too, since the formula definitely doesn’t satisfy her anymore. We started on rice cereal which she seems to like, then moved onto apple sauce, then pears and bananas. I recently introduced sweet potatoes, which she loves. The problem is that she can’t use her upper lip to keep the food in her mouth, so even though she goes for the food and closes her mouth, it all dribbles out. Shelley Cohen (speech pathologist/feeding specialist) at NYU explained this to me when I called to ask about it. She said to thicken the food with rice cereal which will help Emily keep it in her mouth. I tried that and she didn’t like the combination with the sweet potatos, but she doesn’t seem to mind it with the fruit. Eating also makes her sneeze, which causes the food to shoot out of her nose in a most exorcist-like fashion. I guess we will keep trying. I want to ask the early intervention speech therapist if there are excercises we can do to help Emily make use of her new top lip.

Emily had solid food for the first time today. She was four months old yesterday. She seemed to really love it, but it made her gassy. Westarted with rice creal and propped her up in her high chair. The NAM got in the way a lot. We’re going to try it without the NAM soon.

Emily even grabbed the spoon! Then she slid over the to side and started to cry. Ah well…

Feeding Emily has become much easier since she got the NAM in, although she was doing quite well with the Pigeon cleft palate nipple and bottle. Here’s a great page on different bottles you can use for cleft lip and palate. You can order cleft palate Pigeon nursers from this Candadian Web site (even if you’re in the U.S.) or ask your cleft team if they have them on hand. We got a bunch from NYU at a pretty good price.

Anyway, once the NAM was in Emily ate a lot quicker and had to do much less work to get the milk out. This happened because 1) Pigeon nipples are designed to give a “milk reward” to the baby from any action the baby does, e.g., pressing the nipple against her cheek or tongue will extract milk and 2) the NAM gives her lots of surface area to press the nipple against. The combination of the two worked great (since Emily has no palate, she struggled to find a surface to press the nipple against before the NAM was in her mouth. The Pigeon nipple is softer on the bottom and so when she presses her tongue against it, milk automatically squirts down away from her palate – so she rarely has milk come out her nose (unless she spits up – but that’s a different, entirely more exoricst-like story). So that’s one less thing for me to worry about – she can eat. She seems to be a snacker though, and that may be because she’s just getting used to the NAM.